Running, walking and hip pain

The COVID-19 pandemic has brought with it not just health issues, but socioeconomic turmoil, and with enforced closures of sporting facilities, gyms and health centres, many people are being forced to stop their beloved sporting participation and take up different forms of activity.

With limited options available, the walking tracks are a popular choice and people are taking every opportunity to escape the confines of home for some fresh air and exercise.

Whilst the myriad benefits of getting out and about for exercise are proven, the introduction of a new exercise programme or transition from other activities to a lot of walking or running can also result in the development of load-related musculoskeletal problems – and often in the region of the hip and groin.

Sudden increases or decreases in the load or volume of walking or jogging can result in changes in the tissues in and around the hip joint.

Causes of pain in the hip region can be multifactorial and can include gluteal tendinopathy / bursitis, progression of osteoarthritis of the hip joint, hip impingement syndromes and femoral bone stress injury.

Gluteal tendinopathy

Gluteal tendinopathy (1-5) presents predominantly as pain on the lateral side of the hip, and at times as lateral thigh pain.

This condition is also often associated with greater trochanteric pain syndrome (GTPS) or what was traditionally known as trochanteric bursitis.

Symptoms will often include pain on weight-bearing on the affected limb, pain with sleeping (especially lying on the affected side) and pain climbing stairs.

This condition generally affects people who have been inactive and have suddenly increased or taken up walking or running. It is more common in females, with one in four females over 50 years of age likely to be affected.

Osteoarthritis of the hip joint (hip OA)

Hip OA (6-9) commonly presents as pain and stiffness around the hip joint (groin/thigh, buttocks). Pain can develop gradually over time or can be sudden onset due to change in loading through the joint.

The means by which hip pain and stiffness present can vary depending on the stage of osteoarthritis, but it is reassuring that symptoms can often be eased with a well-structured exercise and range of movement programme.

There is excellent evidence behind such rehabilitation, and the GLA:D programme is offered at Lifecare Prahran.

If not managed well, hip OA can also lead to walking / gait abnormalities, other joint issues due to abnormal loading (eg. knee and back pain) and poor quality of life.

Whilst ageing and genetic factors are known contributors to the progression of hip OA, the mechanical loading through the joint is a fundamentally dominant factor.

Hip impingement related hip pain

Femoroacetabular impingement (FAI) (10) is a frequent cause of hip pain and stiffness especially around the hip and groin area. It is a movement related disorder characterised by pain and clinical signs (pinching pain when hip placed into certain positions on examination), further accompanied by specific imagining findings.

FAI is caused by altered bony morphology or shape of the bones of the hip joint (femur and acetabulum) which in turn creates aberrant joint forces during movement  and can result in damage of intra-articular structures like joint cartilage, especially with changes or sudden increase in exercise routines.

Activities like running, acceleration sports, squatting, stairs and prolonged sitting can commonly aggravate the symptoms.

Hip OA can often also be associated with this condition.

Femoral neck stress fractures/reactions

Stress reactions and stress fractures (11) are overuse injuries that are caused by repetitive submaximal loading on a bone over time and associated with increased volume or intensity of training workload.

Over time and under continuing load, stress reactions can worsen to develop stress fractures, and if left unchecked, these can in turn propagate to form complete fractures.

Femoral neck stress fractures make up approximately 11% of bone stress injuries in athletes and are more common in running and jumping related activities.

There are 2 variants of femoral neck stress fractures: tension-type (supero-lateral femoral neck) and compression-type (infero-medial femoral neck).

Clinical suspicion and early detection of femoral neck stress fracture is extremely important as the tension-type fractures (whilst fortunately the much less common variant) carry high risk for propagation to complete fracture.

The more common compressive type of injury is seen in the younger population who are runners.

Common symptoms include hip or groin pain worsened with weight bearing and running (and eased by rest), and some twisting movements of the hip, especially internal rotation.

A detailed blog on stress fractures here.

Our physiotherapists can help you by:

• Providing advice on better management of pain
• Improving range of motion and function
• Providing an appropriate strength and muscle control program
• Guiding a load management program to return to what you love doing
• Educating for prevention of further injuries
• Providing guidance or referral for further imaging (eg x-ray / MRI) if required
• Referring to other specialists (e.g. our sport and exercise physicians or surgeons) if further investigation or intervention is needed

If you are experiencing hip or groin pain, obtaining the right diagnosis and a sound management plan is not only important to manage the current injury and safely return  to the activities you love, but also to make sure you don’t reinjure yourself.

Lakshmi Varma is a Titled Musculoskeletal Physiotherapist with an additional Masters degree in Clinical and Sports Biomechanics. She has over 18 years experience as a Physiotherapist and is currently a PhD student looking at hip replacements.
Lifecare Prahran Sports Medicine is close to suburbs including Malvern, South Yarra, Toorak, Armadale, St Kilda East, Caulfield, Richmond and Hawthorn, and has early and late appointments for all your Sports Medicine and Physiotherapy needs.

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